Quality of life of women who underwent breast cancer treatment relative to sociodemographic, behavioral, and clinical factors

ABSTRACT Objective Patients with cancer often undergo multiple extended treatments that decrease their quality of life. However, the quality of life of women with breast cancer after they undergo treatment remains underexplored in Brazil. Therefore, this study determined sociodemographic, behavioral, and clinical factors related to the post-treatment quality of life of women with breast cancer. Methods This cross-sectional study involved 101 women diagnosed with breast cancer between 2014 and 2016 and treated at a Brazilian Oncology Reference Service. Data were collected from them using face-to-face surveys. Quality of life was evaluated using the European Organization for the Research and Treatment of Cancer Core Quality of Life questionnaire (EORTC QLQ-C30) and EORTC Breast Cancer-specific Quality of Life questionnaire (EORTC QLQ-BR23). The data collected were analyzed using Student’s t-test and Mann-Whitney U test. Results The median score on the global health, functional, and symptom scales of the EORTC QLQ-C30 was 75.00 (Interquartile range=33.33), 75.99 (Standard deviation [SD]=19.26), and 19.67 (SD=16.91), respectively. The mean score on the functional and symptom scales of the EORTC QLQ-BR23 was 61.89 (SD=17.21) and 20.12 (SD=16.94), respectively. Furthermore, higher post-treatment quality of life was found to be associated with being aged 50 or more, being Black, having eight or more years of education, having a partner, having a paying job, receiving treatment from the private healthcare system, having a higher income, living in the municipality where healthcare services are availed, engaging in physical activity, not smoking, being more religious, having more social support, not being overweight, having no comorbidities, and undergoing lumpectomy. Conclusion Sociodemographic, behavioral, and clinical factors significantly impact the quality of life of women who undergo breast cancer treatment. Implementing interventions that improve health and reducing inequalities in the access to healthcare services can improve the quality of life of these patients.


❚ INTRODUCTION
3) Undergoing medical treatment is crucial for preserving life.However, it can also lead to social and psychological transformations and cause lasting damage einstein (São Paulo).(6) One should decide whether to undergo treatment based on the treatment's potential benefits and consequences and whether the benefits outweigh the consequences. (4,7,8)atients with cancer often undergo multiple extended treatments that cause pain and fatigue and disrupt functional ability, social connectedness, sense of wellbeing, and quality of life (QOL). (7)In healthcare, QOL is assessed to gauge the impact of the disease and treatment on the patient's emotional, social, physical, and overall well-being, as well as to guide clinical decisions. (4,6,8)any studies have examined QOL in the context of breast cancer.However, the QOL of women with breast cancer after they undergo treatment remains underexplored in Brazil.

❚ OBJECTIVE
Therefore, this study aimed to determine sociodemographic, behavioral, and clinical factors related to the quality of life of women with breast cancer after they undergo chemotherapy, radiotherapy, or both.

❚ METHODS Study design, participants, and the sample
This cross-sectional study was conducted at a referral center for public and private oncology care in Minas Gerais, Brazil.It was approved by the Ethics Committee of Universidade Federal de Juiz de Fora (CAAE: 05341019.5.0000.5147;# 3.749.693).The target population was women diagnosed with breast cancer between 2014 and 2016 residing in the state of Minas Gerais and receiving follow-up care at an oncology center.Based on analytic cases in the Cancer Hospital Registry, we identified 230 such women.Women undergoing chemotherapy, radiotherapy, or palliative therapy at the time of data collection were excluded.
For 230 eligible women, an estimated prevalence of QOL disorders of 50%, an error of 8%, and a confidence interval of 95%, a minimum of 92 participants was found to be a suitable sample size.Considering a 20% loss, the sample to be recruited was increased to 111.
We attempted to recruit all eligible women, but 57 of them could not be contacted by telephone despite at least three attempts, 45 declined to participate, and 27 did not attend their scheduled recruitment sessions despite confirming appointments on three separate occasions.Therefore, the final sample comprised 101 of the eligible women.

Data collection
Data were collected in two stages.The first stage of data collection was performed between 2018 and 2019.In this stage, we collected information about the participants' diagnosis, treatment, staging, and tumor profiling from their medical records.The second stage of data collection was carried out in 2019.In this stage, the participants were called for a face-to-face survey to address identification issues and collect data on QOL, sociodemographic factors, behavioral factors, and clinical factors.

Variables
(11) With 30 questions, the EORTC QLQ-C30 is a general questionnaire that evaluates symptoms that occurred in the previous two weeks. (11)It has a functional, symptom, and global health scale.The functional scale has subscales for physical, role, emotional, cognitive, and social functions.The symptom scale has subscales for fatigue, nausea, pain, dyspnea, insomnia, loss of appetite, constipation, diarrhea, and financial difficulties.
The EORTC QLQ-BR23 is designed for breast cancer and consists of 23 questions. (11)It has a functional and symptom scale.The functional scale has subscales for body image, future perspectives, sexual functioning, and sexual satisfaction.The symptom scale has subscales for the side effects of systemic therapy, concerns about hair loss, arm-related symptoms, and breast-related symptoms.
The independent variables were sociodemographic factors, behavioral factors, and clinical factors.The sociodemographic factors were age (<50 years/ ≥50 years), self-reported race (white/black), education level (i.e., number of years of education) (<8 years/ ≥8 years), marital status (live with a partner/do not live with a partner), occupation (i.e., whether engaged in a paying job) (yes/no), type of healthcare (public/private), per capita income (≥half of the minimum wage/ <half of the minimum wage), and place of residence (municipality where the service is availed/other municipality).The behavioral factors were self-reported eating habits (good or very good/fair, poor, or very poor), level of physical activity (active or inactive/sedentary), tobacco use (exsmoker or never smoked/smoker), alcohol consumption (≥4 drinks on one occasion/<4 drinks on one occasion), religiosity (≥8 points/ <8 points) and social support (≥45 points/ <45 points).The clinical factors were einstein (São Paulo).2024;22:1-14 surgical intervention (lumpectomy/mastectomy with or without reconstruction), body mass index (normal weight/overweight), presence of comorbidities (i.e., at least one other concomitant disease) (yes/no), and stage (initial -0, I, or II/advanced -III).
Social support was assessed using the Social Support Questionnaire -Short Form, which comprises six questions.For each question, respondents indicate the number of people available to provide support and the degree of satisfaction with the support received. (12,13)esultingly, we obtained a numerical index and a satisfaction index.We summed the scores of the numerical and satisfaction indices.
Religiosity was assessed using the Duke University Religiosity Index, which consists of five items measuring three dimensions of religious involvement related to health outcomes. (14,15)We summed the scores of the three dimensions.
The level of physical activity was measured using the International Physical Activity Questionnaire -Short Form (IPAQ).This questionnaire evaluates the activities one performed (frequency, intensity, and duration) in the last week. (16)Respondents who did not engage in physical activity for at least ten consecutive minutes were considered sedentary.Those who engaged in physical activity for less than 150 minutes were considered inactive.Those who engaged in physical activity for more than 150 minutes were considered active.

Data analysis
We first calculated the absolute and relative frequencies of each variable.To evaluate the correlation between the scores on the EORTC QLQ-C30 and those on the EORTC QLQ-BR23, we used Spearman's rank correlation coefficients.Next, we evaluated the normality of continuous scales using the Kolmogorov-Smirnov test to determine the appropriate statistical test.We employed Student's t-test for variables with a normal distribution and Mann-Whitney U test for those with a non-parametric distribution.All statistical analyses were performed using STATA ® (StataCorp LLC) software, assuming a significance level of 5% for statistical inference.

❚ RESULTS
Among the 101 participants, most were over 50 years of age (70.3%), identified themselves as white (59.4%), had more than eight years of education (59.4%), lived with a partner (53.5%), did not have a paying job (64.0%), received healthcare from the public healthcare system (55.4%),had a per capita income equal to or more than half of the minimum wage (86.6%), and lived in the same municipality as the hospital (80.2%).Regarding behavioral factors, most respondents reported having good eating habits (67.3%), were not sedentary (76.2%), were ex-smokers or had never smoked (91.1%), had less than 4 drinks on one occasion (83.2%), scored less than average on the religiosity scale (64.4%), and scored less than average on the social support questionnaire (52.6%).Regarding clinical factors, most respondents were overweight (64.9%), had comorbidities (66.3%), underwent lumpectomy surgery (91.0%), and were diagnosed in the early stages of the disease (78.2%).
Table 1 presents respondents' scores on the EORTC QLQ-C30 and EORTC QLQ-BR30.The median score on the global health scale of the EORTC QLQ-C30 was 75.00 (Interquartile Range [IQR]=33.33).The Concerning the subscales of the functional scale of the EORTC QLQ-C30, the median score for physical, role, social, cognitive, and emotional function was 86.67, 100, 100, 75.00, and 83.33, respectively.In the symptom scale, the median score was 22.22 for fatigue, 0.00 for nausea, dyspnea, insomnia, loss of appetite, constipation, diarrhea, and financial difficulties, and 16.67 for pain.
Regarding the subscales of the functional scale on the EORTC QLQ-BR23, the median score was 91.67 for body image, 66.67 for future perspectives and sexual satisfaction, and 33.33 for sexual functioning.In the symptom scale, the median score was 14.29, 0.00, 11.11, and 8.33 for side effects of systemic therapy scale, concerns about hair loss, arm-related symptoms, and breast-related symptoms, respectively.
Table 2 presents the results of analyzing the correlation between scores on the EORTC QLQ-C30 and those on the EORTC QLQ-BR23.The global health scale of the EORTC QLQ-C30 was positively correlated with the body image, future perspectives, and sexual satisfaction scales of the EORTC QLQ-BR23 and negatively correlated with the side effects of systemic therapy, concerns about hair loss, arm-related symptoms, and breast-related symptoms scales of the EORTC QLQ-BR23.
The functional scale of the EORTC QLQ-C30 and its subscales were negatively correlated with the side effects of systemic therapy, concerns about hair loss, arm-related symptoms, and breast-related symptoms scales of the EORTC QLQ-BR23 and positively correlated with the body image, future perspectives, sexual functioning, and sexual satisfaction scales of the EORTC QLQ-BR23.
The symptom scale of the EORTC QLQ-C30 and its subscales were negatively correlated with the body image, future perspectives, sexual functioning, and sexual satisfaction scales of the EORTC QLQ-BR23 and positively correlated with the side effects of systemic therapy, concerns about hair loss, arm-related symptoms, and breast-related symptoms scales of the EORTC QLQ-BR23.
Table 3 presents the results of determining differences in respondents' scores on the EORTC QLQ-C30 and EORTC QLQ-BR23 based on sociodemographic factors.Women aged 50 or more (versus younger women) scored better on the emotional function scale of the EORTC QLQ-C30 and the body image, future perspectives, and breast-related symptoms scales of the EORTC QLQ-BR23.However,
White women (versus black women) scored worse on the future perspectives scale of the EORTC QLQ-BR23.Women with eight or more years of education (versus those with fewer years of education) scored better on the physical and role function scales of the EORTC QLQ-C30 and the sexual functioning scale of the EORTC QLQ-BR23.Who lived with a partner (versus those without one) scored better on the functional, physical function, role function, cognitive function, insomnia, appetite, and financial difficulties scales of the EORTC QLQ-C30 and the sexual functioning and side effects of systemic therapy scales of the EORTC QLQ-BR23.
Women with a paying job (versus those without one) scored better on the social function and financial difficulties scales of the EORTC QLQ-C30 and the sexual functioning scale of the EORTC QLQ-BR23.
Women who received care from private healthcare (versus those who received it from public healthcare) scored better on the role function scale of the EORTC QLQ-C30.Women with a per capita income equal to or higher than half of the minimum wage (versus those with a lower per capita income) scored better on the global health, functional, physical function, role function, emotional function, social function, symptom, fatigue, diarrhea, and financial difficulties scales of the EORTC QLQ-C30 and the side effects of systemic therapy, concerns about hair loss, and arm-related symptoms scales of the EORTC QLQ-BR23.Women living in the municipality where they availed oncology services (versus those living in other municipalities) scored better on the global health scale of the EORTC QLQ-C30.
Table 4 presents the results of determining differences in respondents' scores on the EORTC QLQ-C30 and EORTC QLQ-BR23 based on behavioral factors.Women who engaged in physical activity (versus those who did not) scored better on the functional, physical function, cognitive function, and fatigue scales of the EORTC QLQ-C30 and the side effects of systemic therapy scale of the EORTC QLQ-BR23.Women who consumed tobacco (versus those who did not) scored worse on the dyspnea scale of the EORTC QLQ-C30 and the side effects of systemic therapy scale of the QLQ-BR23.Religiosity was found to have a mixed impact on respondents' QOL, as women with high scores on the religiosity scale (versus those with low scores) scored worse on the body image scale of the EORTC QLQ-BR23 but better on the breast-related symptoms scale of the EORTC QLQ-BR23.In contrast, women with high scores on the social support questionnaire (versus those with low scores) scored better on the functional scale of the EORTC QLQ-C30 and the functional, armrelated symptoms, and breast-related symptoms scales of the EORTC QLQ-BR23.Table 5 presents the results of determining differences in respondents' scores on the EORTC QLQ-C30 and EORTC QLQ-BR23 based on clinical factors.Women with normal weight (versus those who were overweight) scored better on the pain scale of the EORTC QLQ-C30 and the arm-related symptoms scale of the QLQ-BR23.Women with at least one comorbidity (versus those without a comorbidity) scored worse on the physical function and insomnia scales of the EORTC QLQ-C30.Women who underwent lumpectomy (versus those who underwent mastectomy) scored better on   M (SD) 3.0 (9.7) 6.6 (15.9) 5.9 (14.1) 4.9 (14.5) 5.9 (14.

❚ DISCUSSION
Scores on the EORTC QLQ-C30 and EORTC QLQ-BR23 were similar to those reported in a Brazilian study involving 172 women, most of whom (77.6%) had completed adjuvant treatment for breast cancer. (17)20) Adjuvant treatment for breast cancer can result in physical, social, and functional changes that affect women's QOL.Nevertheless, these negative effects tend to gradually decline after the completion of systemic treatment. (21)ur respondents had better scores on the functional scales of social function, physical function, and body image as well as the symptom scales of diarrhea, dyspnea, and nausea.These results indicate their ability to recover their social activities and physical well-being after breast cancer treatment, along with the remission of symptoms related to systemic treatment.
However, the respondents scored lower on the functional scales of emotional function, cognitive function, sexual, and future perspectives.These findings suggest the presence of long-term effects of therapy and concerns about the future, which highlights the need to adopt a broader and more continuous approach by a multi-and interdisciplinary health team.Regarding the symptom scales, the worst scores were associated with pain and insomnia, which are nonspecific symptoms that might be influenced by the patient's lifestyle rather than being directly linked to breast cancer.
Overall, our results indicate promising improvements in various aspects of patients' lives after they receive breast cancer treatment.However, they also highlight the importance of addressing the emotional, cognitive, and sexual well-being of these women in the follow-ups.
Regarding the factors related to the post-treatment QOL of women with breast cancer, women aged 50 or more had better scores on the emotional function scale of the EORTC QLQ-C30 and the body image, future perspectives, and breast-related symptoms scales of the EORTC QLQ-BR23 but worse scores on the sexual functioning scale of the EORTC QLQ-BR23.This finding is similar to that of a literature review that found that older women are more mentally prepared to deal with treatment. (22)However, the impact of age on the QOL of patients with breast cancer remains a matter of debate, with some studies indicating that older women may have worse overall QOL. (23)ging can decrease functional capabilities and QOL, but older women may have already undergone such changes because of other conditions.Thus, the decline in their QOL from breast cancer treatment may not be as severe as that in younger women.Furthermore, young individuals are subjected to society-defined beauty standards, but this subjection is less evident for older individuals. (24)enopause causes hormonal changes that can be exacerbated by breast cancer treatment. (25)This may explain why older women had lower scores for sexual functioning.A study conducted in Curitiba involving 48 patients with breast cancer obtained similar results. (26).Continuation White women had worse scores on the future perspectives scale of the EORTC QLQ-BR23.Race is an indirect indicator of socioeconomic status, access to health services, and information about diseases.Therefore, white women may have more information about the severity and symptoms of breast cancer, causing greater concerns about the future. (27)omen with eight or more years of education had better scores on the physical and role function scales of the EORTC QLQ-C30 and the sexual functioning scale of the EORTC QLQ-BR23.A Polish study involving 324 women with breast cancer also found that women with higher educational levels have better QOL.Higher education levels were found to be associated with a better understanding of health guidelines, the ability to identify changes caused by treatment, and the tendency to seek more health services. (28)Thus, women with higher educational levels may have the opportunity to access therapies and treatments that improve their functional abilities and sexual function.Additionally, education is related to increased health awareness, improvements in self-care, and the ability to cope with the side effects of treatment. (27,29)omen who lived with a partner scored better on the functional, physical function, role function, cognitive function, insomnia, loss of appetite, and financial difficulties scales of the EORTC QLQ-C30 and the sexual function and side effects of systemic therapy scales of the EORTC QLQ-BR23.This result is consistent with the findings of a Polish study that found that married women have higher QOL due to greater family support in coping with the disease. (28)omen who had a paying job had better scores on the social function and financial difficulties scales of the EORTC QLQ-C30 and the sexual functioning scale of the EORTC QLQ-BR23.This result aligns with the findings of a study conducted in Barretos, São Paulo, involving 304 women with breast cancer.It found that women who return to work after treatment have higher QOL.Having a job can provide social contact and financial stability, contributing to a higher QOL.This may explain, at least in part, the higher scores on the social function, financial difficulties, and sexual functioning scales.However, economically active women generally have better health, allowing them to work. (30)omen receiving care from the private healthcare system scored better on the role function scale of the EORTC QLQ-C30.This finding aligns with that of a study conducted in Curitiba.It found that patients with breast cancer receiving private care have better QOL.In private services, access regulation does not follow the principle of hierarchy.Thus, access to specialized care can be facilitated, which can lead to less aggressive treatment and access to specific therapies, resulting in an improved QOL. (31) Women with a per capita income equal to or higher than half of the minimum wage scored better on the global health, functional, physical function, role function, emotional function, social function, symptoms, fatigue, diarrhea, and financial difficulties scales of the EORTC QLQ-C30.They also scored higher on the side effects of systemic therapy, concerns about hair loss, and arm-related symptoms scales of the EORTC QLQ-BR23.This result is consistent with the findings of a study conducted in Vitória, Espírito Santo. (32)A higher income can provide greater access to healthcare and disease information as well as treatments that alleviate side effects, leading to better QOL. (28)omen living in the municipality where they availed oncology services scored better on the global health scale of the EORTC QLQ-C30.Similar results were found in a Polish study involving 250 women with breast cancer.The study found that being close to wellequipped healthcare centers grants women with breast cancer access to medical specialists, medical tests, and health information, leading to better QOL. (29)hysically active women scored better on the functional, physical function, cognitive function, and fatigue scales of the EORTC QLQ-C30 and the side effects of systemic therapy scale of the EORTC QLQ-BR23.An intervention study involving women diagnosed with breast cancer and aromatase inhibitors found improvements in the QOL domains of the group that engaged in physical activity.Physical activity can improve several aspects of QOL, such as functional performance, strength, aerobic capacity, and sleep quality, and reduce adverse effects. (33)omen who consumed tobacco scored worse on the dyspnea scale of the EORTC QLQ-C30 and the side effects of systemic therapy scale of the EORTC QLQ-BR23.A study in Poland involving 250 women with breast cancer also found that tobacco use results in lower QOL.Tobacco consumption harms the pulmonary and circulatory systems, thereby negatively affecting one's QOL. (29)omen with high scores on the religiosity scale scored worse on the body image scale of the EORTC QLQ-BR23 but better on the breast-related symptoms scale of the EORTC QLQ-BR23.A study conducted in Porto Alegre evaluated 108 women with breast cancer and found a correlation between QOL and spirituality.Spirituality is an effective strategy for reducing suffering and can provide comfort, faith, peace, and a sense of purpose during challenging times. (19)instein (São Paulo).2024;22:1-14 Women with high scores on the social support questionnaire scored better on the cognitive function scale of the EORTC QLQ-C30 and the functional, armrelated symptoms, and breast-related symptoms scales of the EORTC QLQ-BR23.A Chinese study involving 98 women with breast cancer found that women with more social support have better QOL.Social support helps individuals cope with adverse situations, such as breast cancer, and positively affects both physical and mental health, especially under stressful conditions. (34)omen with normal weight scored better on the pain scale of the EORTC QLQ-C30 and the armrelated symptoms scale of the EORTC QLQ-BR23.This result is consistent with the findings of a Polish study involving 250 women with breast cancer.The study found that obesity is a well-established risk factor for the development, progression, and recurrence of breast cancer, can negatively influence treatment effectiveness, and cause complications. (29)Body weight is often linked to one's lifestyle and significantly affects QOL.
Women with at least one comorbidity scored worse on the physical function and insomnia scales of the EORTC QLQ-C30.A study involving 114 American women with breast cancer found worse QOL in patients with comorbidities. (35)The presence of comorbidities can worsen functional limitations and symptoms associated with the disease, thereby affecting various aspects of QOL. (29)omen who underwent lumpectomy scored better on the role and loss of appetite scales of the EORTC QLQ-C30 and the sexual functioning and concerns about hair loss scales of the EORTC QLQ-BR23.A study conducted in Florianópolis, Brazil, involving 172 women with breast cancer found that women who underwent radical surgery had lower QOL scores than those who underwent lumpectomy. (17)Breasts have a cultural and social significance in women's experience of sexuality, and any threat to its integrity can cause feelings of inferiority, rejection, and loss of self-esteem.Surgical intervention and the side effects of systemic treatments can lead to psycho-emotional challenges for women with breast cancer, impacting their body image and sexuality. (21)wing to improvements in therapies, the QOL of patients undergoing breast cancer treatment has improved in recent years.However, aspects such as emotional function, body image, sexual function, and concerns about future perspectives require attention from healthcare professionals.
In Brazil, primary healthcare, which is considered the gateway to the healthcare network, plays a key role in monitoring patients with breast cancer, especially more vulnerable patients.This monitoring can be improved by establishing matrix support and shared care between primary care and referral centers for cancer care.However, not all Brazilian municipalities have full coverage of primary care services.Moreover, the workload of primary care teams and the large number of incomplete teams, especially teams of community health agents, pose challenges to providing this care.
Due to the complex nature of the construct of QOL, multidisciplinary teams and intersectoral partnerships must be developed to provide effective breast cancer treatment and overcome access barriers and health inequalities in Brazil.
Despite the limitations stemming from the subjectivity of QOL and its measurement, we used validated instruments to minimize bias.Although the sample size was not too large, no differences were observed between the women included in the study (n=101) and those eligible for the study (n=129) in terms of sociodemographic factors such as age, education, race, marital status, comorbidities, stage of illness, and type of care.Thus, the risk of bias due to unequal loss of participants was reduced.
Additionally, measuring QOL at least three years after diagnosis resulted in greater homogeneity among the study population.It also allowed us to analyze longterm effects in women who had not relapsed, minimizing the impact of the initial discovery and acceptance of the disease and the often more aggressive therapy administered during that phase.

❚ CONCLUSION
Higher post-treatment quality of life of women with breast cancer is associated with being Black, being 50 years old or older, having eight or more years of education, having a partner, having a paying job, receiving care from the private healthcare system, having a per capita income equal to or more than half of the minimum wage, living in the municipality where the healthcare service is located, engaging in physical activity, not consuming tobacco, being highly religious, having more social support, not being overweight, having no comorbidities, and undergoing lumpectomy.
These findings suggest that sociodemographic, clinical, and lifestyle factors influence the quality of life of women with breast cancer, even after a few years of diagnosis.Interventions aimed at promoting health and reducing inequalities in access to healthcare can mitigate cancer-related symptoms and enhance the quality of life of survivors of breast cancer, even after the end of chemotherapy or radiotherapy.
einstein (São Paulo).2024;22:1-14 The results of this study broaden our understanding of sociodemographic, behavioral, and clinical factors that influence post-treatment quality of life of Brazilian women diagnosed with breast cancer.Longitudinal studies should be conducted to investigate the correlations reported in this study.They should also include variables such as environmental conditions, multidisciplinary support, and mental health factors.

❚ ACKNOWLEDGMENTS
We sincerely acknowledge all professionals at the Hospital Nove de Julho/ Instituto Oncológico de Juiz de Fora, Minas Gerais, Brazil, and all patients who participated in this study.This study was funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) -process: 313423/2021-0 and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) -process: 32005016014P7.

❚ AUTHORS' CONTRIBUTION
Angélica Atala Lombelo Campos, Maria Teresa Bustamante-Teixeira, Rafaela Russi Ervilha, Vivian Assis Fayer, Jane Rocha Duarte Cintra, Renata Mendes de Freitas, Daniela Pereira de Almeida, and Maximiliano Ribeiro Guerra: substantial contributions to the conception and design, data collection, data analysis and interpretation, article writing, relevant critical review of intellectual content, and final approval of the version to be published.

Table 2 .
Spearman correlation coefficients between the scale values of the QLQ-C30 and QLQ-

BR23 questionnaires Functional scale Body image Future perspectives Sexual functioning Sexual satisfaction Symptom scale Side effects of systemic therapy Concerns about hair loss Arm- related symptoms Breast- related symptoms
* Statistical significance of p<0.05; ** Statistical significance of p<0.01.

Table 3 .
Quality of life of the women who participated in the study on the scales of the QLQ-C30 and QLQ-BR23 questionnaires according to sociodemographic characteristics

Table 3 .
Quality of life of the women who participated in the study on the scales of the QLQ-C30 and QLQ-BR23 questionnaires according to sociodemographic characteristics

Table 4 .
Quality of life of the women who participated in the study on the scales of the QLQ-C30 and QLQ-BR23 questionnaires according to behavioral characteristics

Table 4 .
Quality of life of the women who participated in the study on the scales of the QLQ-C30 and QLQ-BR23 questionnaires according to behavioral characteristics

Table 5 .
Quality of life of the women who participated in the study on the scales of the QLQ-C30 and QLQ-BR23 questionnaires according to clinical characteristics

Table 5 .
Quality of life of the women who participated in the study on the scales of the QLQ-C30 and QLQ-BR23 questionnaires according to clinical characteristics einstein (São Paulo).2024;22:1-14